1 / 15

Hepatitis C Treatment in a Cirrhotic Patient: Case Study and Therapeutic Decisions

This case study highlights the management of a 48-year-old male with a history of intravenous drug use and hepatitis C. He presents with liver abnormalities, including elevated AST and bilirubin levels, and thrombocytopenia. After the initiation of treatment with PegINF and ribavirin, we monitor HCV RNA levels and the patient's overall health. Despite experiencing severe nausea and abdominal issues, adjustments to the therapy regimen are made. The case discusses critical decision points regarding treatment adherence, dose adjustments, and the appropriateness of response-guided therapy.

lita
Télécharger la présentation

Hepatitis C Treatment in a Cirrhotic Patient: Case Study and Therapeutic Decisions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE 2 • 48 yo man • IVDU in past….last used 27 yrs ago • Stable social situation • Currently receiving social assistance with provincial drug coverage • No comorbid disease

  2. CASE 2 Hepatitis C disease parameters • Secondary workup negative…no co-infections • HCVRNA 3.65 x 10E7 iu/ml • genotype 1a

  3. CASE 2 Hepatitis C disease parameters • AST>ALT • Platelets 71 • INR 1.5 • Bilirubin 38 mmol/l

  4. CASE 2 Hepatitis C disease parameters • Clinically…no previous ascites/edema, encephalopathy or GI bleeds • Imaging…coarse liver/14cm spleen/no free fluid/no varices seen • OGD…no varices

  5. CASE 2 Under what circumstances would you not treat a cirrhotic patient for Hepatitis C? • Ascites…previous vs current • Encephalopathy • Portal Hypertension without previous bleed/with previous bleed • Are there biochemical exclusionary criteria for treatment

  6. CASE 2 Treatment initiated with Peg INF/1400mg RBV (90kg) Week 0 HCVRNA…3.65x 10E7 Week 4 HCVRNA…1.12x10E2 • Severe nausea/intolerable…RBV decreased to 1200mg/day

  7. CASE 2 Peg INF/1200mg RBV (90kg) Week 4-8 • Increasing abdominal girth/soas responsive to a slow diuresis with furosemide and salt restriction • No encephalopathy • SBP prophylaxis initiated

  8. CASE 2 Peg INF/1200mg RBV (90kg) Week 4-8 • Increase in bilirubin from 40 to 75 then stabilized • Inr increased from 1.5 to 1.7 then stabilized • Plts decreased from 80 to 40 then stabilized • Renal function stable throughout with creatinine at 55 mmole/l

  9. CASE 2 Peg INF/1200mg RBV (90kg) Week 0 HCVRNA…3.65x 10E7 Week 4 HCVRNA…1.12x10E2 Week 8 HCVRNA…8.80x10E1

  10. CASE 2 Peg INF/1200mg RBV (90kg) Week 8 • Stable clinically with 1.5 kg of weight loss weekly and tolerating therapy day-day relatively well • Warned of concerns re: stalling of HCVRNA but decision to continue therapy made

  11. CASE 2 Peg INF/1200mg RBV (90kg) Week 0 HCVRNA…3.65x 10E7 Week 4 HCVRNA…1.12x10E2 Week 8 HCVRNA…8.80x10E1 Week 12 HCVRNA…5.40 x 10E1 WHAT WOULD YOU DO TODAY?

  12. CASE 2 Peg INF/1200mg RBV (90kg) Week 12 • Boceprevir access arranged and therapy initiated at 800mg Q8H

  13. CASE 2 Peg INF/1200mg RBV/Boceprevir 800mg Q8H (90kg) Week 12-16 • Adherent with all meds and Boceprevir addition tolerated well • Erythropoietin initiated at week 15

  14. CASE 2 Peg INF/1200mg RBV/Boceprevir 800 mg Q8H (90kg) Week 0 HCVRNA…3.65x 10E7 Week 4 HCVRNA…1.12x10E2 Week 8 HCVRNA…8.80x10E1 Week 12 HCVRNA...5.40x10E1 Week 16 (week 8)….undetectable

  15. CASE 2 Questions: • Do you think the dose reduction of RBV by 200mg stalled the progress of therapy? • How long will you treat…is response guided therapy appropriate for this naïve patient? • If week 16 (week 8 of triple therapy) was still detectable would you have continued with therapy?

More Related